大面积烧伤的综合治疗措施

Comprehensive Treatment of Extensive Burn

目的总结大面积烧伤的综合治疗经验。方法回顾性分析1994年1月1日至2005年1月1日收治的大面积烧伤患者共93例,以1999年1月1日为界分成两组,之前的49例为A组,之后的44例为B组。A组治疗方法较为局限,B组应用新的综合治疗措施,包括休克期快速补液,早期胃肠道营养,早期大面积切削痂手术,功能部位早期大张自体皮覆盖,早期进行系统功能锻炼等。比较两组补液量、切削痂时间及面积、创面愈合时间、并发症发生率、死亡率。结果与A组相比,B组补液量明显增加(P<0.01),切削痂时间提前、面积增加(P<0.05),创面愈合时间显著缩短(P<0.01)。A组发生并发症27例,B组15例;A组死亡12例,分别死于烧伤脓毒症6例,急性肾功能衰竭4例,多器官功能衰竭2例;B组死亡4例,分别死于多器官功能衰竭1例、烧伤脓毒症2例、呼吸道大出血窒息1例。B组并发症发生率、死亡率均低于A组(P<0.05)。结论大面积烧伤的综合治疗可显著提高临床治愈率,缩短创面愈合时间,减少并发症,降低死亡率。

Objective To summarize the experience of comprehensive treatment of extensive burn. Method 93 cases of extensive burn from 1994 to 2005 were divided into two groups ： group A （ n = 49） admitted prior to 1999, group B （n = 43） admitted after 1999 which received the comprehensive treatment, including fast fluid resuscitation in shock stage, early enteral nutrition, early eschar shaving, early skin autograft on functional site and early functional excise. The volume of fluid input, time and area of eschar shaving, duration of wound healing, incidence of complication and mortality were comparatively analyzed between two groups. Result Compared with group A, group B had significant higher volume of fluid input（P 〈 0.01 ）, shorter duration before first time and larger area of eschar shaving（ P 〈 0. 05 ）, shorter duration of wound healing（P 〈 0.01 ）. Complications occurred in 27 cases of group A and 15 cases of group B. There were 12 deaths in group A, including 6 cases died of sepsis, 4 cases died of acute renal failure, 2 cases died of MOF, and 4 deaths in group B, including 1 case of MOF, 2 cases of sepsis, 1 case of apnoea due to respiratory tract bleeding. The rates of complication and mortality were significant lower in group B（P 〈0.01 ）. Conclusion Comprehensive treatment for extensive burn can improve the cure rate, shorten wound healing duration, lower complication and mortality.